Ventricular Fibrillation Treatment Guidelines

Initial Response and Assessment

The American Heart Association recommends recognizing ventricular fibrillation on cardiac monitor as disorganized electrical activity without discernible QRS complexes 3
High-quality CPR should be started immediately with minimal interruptions, at a rate of at least 100 compressions per minute and a depth of 2/3 anterior-posterior chest diameter, as recommended by the American Heart Association 1
A monitor/defibrillator should be attached as soon as possible, according to the American Heart Association guidelines 1
The American Heart Association advises minimizing interruptions in chest compressions, including during rhythm analysis, to ensure high-quality CPR 3

The American College of Cardiology recommends delivering an immediate unsynchronized shock for witnessed ventricular fibrillation arrest, with an initial shock energy of 200J (monophasic) or the manufacturer's recommended dose (biphasic) 4, 5
If the initial shock is unsuccessful, the American College of Cardiology suggests delivering a second shock at 200-300J, and a third shock at 360J if necessary 5, 6
For unwitnessed arrest or prolonged ventricular fibrillation, the American Heart Association recommends considering 2 minutes of CPR before the first shock 3
The American Heart Association advises resuming CPR immediately after each shock, beginning with chest compressions, to maintain high-quality compressions 1, 3

The American Heart Association recommends establishing IV/IO access while continuing CPR, and administering epinephrine 1mg IV/IO every 3-5 minutes 1, 4
The American College of Cardiology suggests considering lidocaine 1.5mg/kg IV/IO if amiodarone is unavailable 5

The American Heart Association recommends considering advanced airway placement after initial shocks if personnel are available, and delivering 1 breath every 6 seconds (10 breaths/min) with continuous compressions if an advanced airway is placed 1
The American Heart Association advises using waveform capnography to confirm and monitor endotracheal tube placement 1

The American Heart Association recommends using 2 J/kg for the first shock, 4 J/kg for the second shock, and 4-10 J/kg for subsequent shocks in pediatric patients 1, 7
The American Heart Association suggests considering reversible causes (Hs and Ts): Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis (pulmonary and coronary) 1

The American Heart Association recommends maintaining adequate ventilation and oxygenation after return of spontaneous circulation (ROSC) 1
The American College of Cardiology advises correcting electrolyte abnormalities, particularly potassium and magnesium, after ROSC 5, 8
The American College of Cardiology suggests considering beta-blockers if ventricular fibrillation occurred in the setting of acute myocardial infarction 5

The American Heart Association recommends not delaying defibrillation for witnessed ventricular fibrillation arrest, and avoiding excessive interruptions in chest compressions, including for rhythm checks 1, 3, 8
The American Heart Association advises not using synchronized cardioversion for ventricular fibrillation (always using unsynchronized shocks) 2
The American Heart Association suggests avoiding excessive ventilation, which can decrease cardiac output during CPR 1